Leading expert in multiple sclerosis and neuroimmunology, Dr. Howard Weiner, MD, explains the evolution of MS treatment. He details the shift from broad immunosuppressants to targeted immune modulators. Newer therapies, like anti-B-cell antibodies, offer improved efficacy with a better safety profile. These advanced treatments are administered via infusion and represent a significant breakthrough in managing the disease.
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Advanced Immune Modulators for Multiple Sclerosis Treatment
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- Evolution of MS Therapy from Immunosuppression to Immune Modulation
- B-Cell Targeting: A New Frontier in MS Treatment
- Administration Routes for Modern MS Medications
- Safety Profile of Newer Immune Modulating Therapies
- Clinical Implications for Patients with Multiple Sclerosis
- Full Transcript
Evolution of MS Therapy from Immunosuppression to Immune Modulation
Dr. Howard Weiner, MD, a pioneer in multiple sclerosis treatment, discusses the historical use of medications like cyclophosphamide. He clarifies that while these early immunosuppressive drugs were a breakthrough, modern therapy has evolved significantly. Dr. Howard Weiner, MD, emphasizes that almost all MS medications affect the immune system, but he prefers the term "immune modulators" for newer agents. This shift reflects a move from non-specific suppression to more precise targeting of immune pathways.
B-Cell Targeting: A New Frontier in MS Treatment
The latest major advancement in multiple sclerosis treatment involves therapies that specifically target B-cells. Dr. Howard Weiner, MD, highlights that this approach is highly effective against the disease. He notes an important historical connection: older drugs like cyclophosphamide also affected B-cells, but in a much less specific way. This new generation of anti-B-cell antibodies represents a more sophisticated and targeted form of immune modulation, building on the foundational research of the past.
Administration Routes for Modern MS Medications
Dr. Anton Titov, MD, inquires about how these new multiple sclerosis medications are delivered to patients. The innovative B-cell targeting therapy is administered via infusion. Dr. Howard Weiner, MD, confirms this, adding that other oral multiple sclerosis medications are also available which target different immune cells. This variety in administration routes—from infusion to oral—provides neurologists and patients with more options to tailor treatment plans to individual needs and lifestyles.
Safety Profile of Newer Immune Modulating Therapies
A critical concern with any immune-based therapy is its side-effect profile. Dr. Anton Titov, MD, directly asks Dr. Howard Weiner, MD, to compare the risks of classical immunosuppressants versus these new medications. Dr. Weiner confirms that the newer therapies do not carry the same level of risk as the old immunosuppressants. The targeted nature of anti-B-cell antibodies means they have a much more favorable safety and risk profile for the patient with multiple sclerosis, which is a significant clinical advantage.
Clinical Implications for Patients with Multiple Sclerosis
The development of targeted immune modulators marks a profound improvement in multiple sclerosis care. Dr. Howard Weiner, MD, explains that these treatments offer potent efficacy without the broad toxicity of older drugs. This advancement allows for more aggressive control of the disease while maintaining a focus on patient safety and quality of life. The conversation between Dr. Anton Titov, MD, and Dr. Weiner underscores a hopeful future where MS can be managed more effectively and safely than ever before.
Full Transcript
Dr. Anton Titov, MD: You are one of the pioneers in using immunosuppressive medications like cyclophosphamide in the treatment of multiple sclerosis. These medications have been used for quite some time. Now there are more disease-modifying multiple sclerosis therapies that are becoming available. What is the role for immunosuppressive medications in the treatment of multiple sclerosis?
Dr. Howard Weiner, MD: Almost all of the medications we have for multiple sclerosis affect the immune system. I would call them immune modulators.
One of the newest medications that just came out targets B-cells. That medication has a very good effect in multiple sclerosis. That is probably the latest big medication we have for multiple sclerosis.
We don't use a lot of cyclophosphamide anymore. Our work on cyclophosphamide was a breakthrough that showed the immune suppression or immune modulation.
We now have more sophisticated medications. But the new medications affect cells that the cyclophosphamide affected. For example, cyclophosphamide affected B-cells. Now we have a new medication that affects B-cells.
Dr. Anton Titov, MD: Is that injectable or oral multiple sclerosis medications?
Dr. Howard Weiner, MD: The new multiple sclerosis medication targets B-cells by infusion. Then there are other oral multiple sclerosis medications that target other cells.
Dr. Anton Titov, MD: These newer multiple sclerosis medications—how is their risk profile and side effects? Because obviously immunosuppressive therapy has a lot of side effects. How is the risk profile of newer multiple sclerosis medications compared to the classical multiple sclerosis medications?
Dr. Howard Weiner, MD: Newer medications don't have as many risks. The new anti-B-cell antibodies are not as risky as the old immunosuppressants.
Dr. Anton Titov, MD: They have a much better risk profile for the patient with multiple sclerosis?
Dr. Howard Weiner, MD: Yes. New therapies for multiple sclerosis target specific immune cells, like B-cells.